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Ruth E Johnson, Cindy A Kermott, M Hassan MuradMayo Clinic, Division of Preventive, Occupational and Aerospace Medicine, Rochester, Minnesota, USADate of preparation: 11th January 2011Conflict of Interest: None declaredClinical question: What is the best management approach for gynecomastia?Results: In most patients, surgical correction usually leads to immediate cosmetic and symptomatic improvement and is considered the best approach. In men who are being treated with antiandrogen therapies, pharmacological intervention with tamoxifen is the most effective approach, followed by radiotherapy.Implementation: Pitfalls to avoid when treating gynecomastia - Failure to detect the very rare male breast cancer - Overly aggressive early intervention or evaluation - Appropriate medical intervention - When to refer to specialist treatmentKeywords: gynecomastia, testosterone, estrogen

Abstract Earthworm, Eudrilus eugeniae cannot survive and regenerate without clitellum segments. In regenerating worms, the clitellum’s epithelial and circular muscular layers are reduced to one-third, and longitudinal cell layers to half. In C2C12 cells, Clitellum Factors (CF − 5, 25 and 50%) and Regenerative Clitellum Factors (RCF − 5, 25, 50, 75%) ameliorate the cell viability up to 20–28% and 30–38% respectively than the control. In contrast, extracts from body segments negatively influence cell viability up to 80%. In a scratch-wound assay, 25% RCF and 5% CF achieved 99.86% and 81.54% wound closure in 24 h, respectively, compared to 40% in controls. RCF and CF also possess enhanced anti-microbial activity against gram + ve bacteria. Western Blotting reveals that Wnt3a, HoxD3 and VEGF were remarkably upregulated in RCF and CF treated samples and their upregulated stemness property is effectively regulated by p53, TCTP, H2AX, Cleaved Caspase-3 proteins. Immunofluorescence data clearly states that Wnt3a and Caspase-3 signals are more profoundly observed in nuclear over cytoplasm in RCF treated samples and H2AX shows less nuclear signals than CF. In in-vivo earthworm model conditions, RCF remarkably promotes the survivability and wound healing ability by promoting the Wnt3a and VEGF expression together with downregulation of Cox2.

An advanced undergraduate laboratory project is described that integrates inorganic, analytical, physical, and biochemical techniques to reveal differences in binding between cationic metal complexes and anionic DNA (herring testes). Students were guided to formulate testable hypotheses based on the title question and a list of different metal complexes. Student teams synthesized the target complexes, such as tris(1,10-phenanthroline)cobalt(III) or tris(2,2'-bipyrydyl)cobalt(III), and characterized them by voltammetry and spectroscopy. Separately, DNA stock solutions were prepared and analyzed via published spectroscopic methods. Aliquots of the DNA solutions, added into a metal-complex solution, gave decreases in the cyclic voltammetry peak currents due to the slower diffusion rate of the DNA-metal complex. A nonlinear curve fit analysis of the 1:1 binding isotherms confirmed the literature result (unknown to students) of larger binding constants for the phenanthroline complex due to intercalative binding. Student team results were shared in a group meeting and assessment was by group reports and individual portfolios. The project was an effective way to link the various laboratory techniques common to the chemical disciplines and encouraged team building in a research atmosphere. (Contains 4 figures and 1 scheme.)

Abstract Perionyx excavatus, an indigenous earthworm possesses exceptional regeneration capacity. Their anterior regeneration features wound closure, regeneration induction and morphogenesis of damaged organs. This study involved a complete analysis of their transcriptomic dataset, with an emphasis on identifying the genes expressed during regeneration and predicting their implications in the process of regeneration and morphogenesis. Control (first ten segments) and test (5th day blastema) RNA samples of biological replicates were isolated and sequenced on NovaSeq. 6000 using PE150 read length. An average of 98.64% of high-quality data was retained with assembly showing better continuity with the average transcript length with 823 bp and N50 value of 1,858 bp. This is the first report on the comparative transcriptome of P. excavatus during anterior regeneration and this study will shed light on the complexity of annelid regeneration.

This study aims to develop scaffolds (CCS, CCS-SeNPs, CCS-SA-SeNPs, and CCS-PET-SeNPs) with enhanced mechanical strength, thermal stability, and antioxidant properties to improve cell attachment and proliferation of the C2C12 cell line for cardiac health applications. Collagen and chitosan are popular biopolymers in tissue engineering for their biocompatibility, biodegradability, and support for cell growth. Selenium nanoparticles (SeNPs) are incorporated into scaffolds for their antioxidant, anti-inflammatory, and antimicrobial properties, which enhance tissue regeneration. Sodium alginate and pectin, natural polysaccharides, further modify these scaffolds to improve structural and functional properties. Developing these composite scaffolds aims to optimize biomaterial performance in regenerative medicine. In the present study, various types of scaffolds (CCS, CCS-SeNPs, CCS-SA-SeNPs, and CCS-PET-SeNPs scaffolds) were prepared and characterized using X-ray diffraction (XRD), Scanning Electron Microscopy with Energy Dispersive X-ray Spectroscopy (SEM-EDX), and Thermo-Gravimetric Analysis (TGA). The XRD data revealed that all the scaffolds (CCS, CCS-SeNPs, CCS-SA-SeNPs, and CCS-PET-SeNPs) displayed an amorphous structure. SEM analysis demonstrated that the CCS and CCS-SA-SeNPs scaffolds exhibit solid-walled metrics and a smooth surface. EDX confirmed the homogeneous Se distribution within the scaffolds. The tensile strength of CCS, CCS-SeNPs, CCS-SA-SeNPs, and CCS-PET-SeNPs scaffolds was found to be 5.15 N, 4.77 N, 4.05 N, and 4.01 N, respectively. Thermal stability assessments showed that CCS-SeNPs, CCS-SA-SeNPs and CCS-PET-SeNPs scaffolds displayed good thermal stability, with maximum decomposition occurring at 250 °C. Furthermore, the CCS-SeNPs, CCS-SA-SeNPs, and CCS-PET-SeNPs scaffolds showed notable antioxidant activity of ∼ 57 %, compared to the CCS scaffold’s 42 %. Morphological studies of C2C12 cells on these scaffolds showed better proliferation on SeNPs-enhanced scaffolds. Nucleus morphology remained unchanged, indicating no adverse effects from SeNPs. The results indicate that the scaffolds (CCS, CCS-SeNPs, CCS-SA-SeNPs, and CCS-PET-SeNPs) demonstrate notable enhancements in mechanical strength, thermal stability, and antioxidant efficacy. These advancements are anticipated to promote enhanced cell adhesion and proliferation of the C2C12 cell line, thereby emphasizing their potential utility in cardiac health applications.

Abstract Fetal bovine serum (FBS) plays a pivotal role in animal cell culture. Due to ethical and scientific issues, searching for an alternative, comprising the three R’s (Refinement, Reduction and Replacement) gained global attention. In this context, we have identified the heat inactivated coelomic fluid (HI-CF) of the earthworm, Perionyx excavatus as a potential alternative for FBS. Briefly, we formulated HI-CF (f-HICF) containing serum free medium which can aid the growth, attachment, and proliferation of adherent cells, similar to FBS. In this study, we investigated the biochemical characterization, sterility, stability, formulation, and functional analysis of HI-CF as a supplement in culturing animal cells. Notably, vitamins, micronutrients, proteins, lipids, and trace elements are identified and compared with FBS for effective normalization of the serum free media. HI-CF is tested to be devoid of endotoxin and mycoplasma contamination thus can qualify the cell culture grade. The f-HICF serum free media was prepared, optimised, and tested with A549, HeLa, 3T3, Vero and C2C12 cell lines. Our results conclude that f-HICF is a potential alternative to FBS, in accordance with ethical concern; compliance with 3R's; lack of unintended antibody interactions; presence of macro and micronutrients; simple extraction; cost-effectiveness and availability.

Fetal bovine serum (FBS) is a widely used growth supplement in the in vitro culturing of animal and human cells, tissues and organs, notably due to the occurrence of abundant micro- and macronutrients, along with growth factors. Over the years, increasing demand, high price, batch-to-batch variability in quality and composition, increasing ethical concerns lead to the search for an alternative to FBS. Several approaches have been suggested and employed in the past, but none is implemented as widely as FBS, and each supplement has its own disadvantages. In this review, we described the importance of FBS in cell culture, discussed the issues associated with FBS use and presented the efforts made in the recent past to reduce or replace FBS. The potential of four different alternative sources to FBS, namely, bovine ocular fluid, sericin protein, human platelet lysate and earthworm heat inactivated coelomic fluid was evaluated. In the end, we present the conceptual perspective using the Human Platelet Lysate (HPL) and earthworm Heat Inactivated Coelomic Fluid (HI-CF) combination to alternate FBS and its context in scientific and economic impacts.

Two heterocyclic Schiff bases namely (E)-2-(1-(2-phenylhydrazono)ethyl)pyridine (or 2-acetyl pyridine phenyl hydrazone) (2APPH) and (E)-2-(1-triazylidineethyl)pyridine (or 2-acetyl pyridine semicarbazone) (2APSC) were synthesized, characterized and their corrosion inhibition behaviour as well as mechanism of inhibition were investigated by different techniques. Structural characterization includes NMR, Mass, IR and UV-visible spectroscopy and elemental analysis. Corrosion inhibition behaviour of aforesaid compounds on mild steel in 1M hydrochloric acid was examined by electrochemical methods including potentiodynamic polarization analysis and electrochemical impedance spectroscopic techniques. The mechanism of corrosion inhibition was explored and supplemented by adsorption and surface morphological studies. Quantum mechanical investigations on corrosion behaviour of compounds were also conducted and satisfying correlation was noticed between the results of corrosion measurement methods and quantum mechanical evaluations.

OBJECTIVE: Obesity has become a public health epidemic in adults and children. Clinician practices need new models to effectively address overweight in patients, yet, practices lack time and resources. We tested a clinician-delivered intervention that utilized community resources for in-depth counseling for unhealthy behaviors including overweight. METHODS: Eligible patients in nine primary care practices were identified using an electronic linkage system (eLinkS) which also automated patient referrals to group (Weight Watcher's), telephone counseling (TC), or usual care. Pre/post-survey data were used to assess factors related to counseling choices as well as changes in BMI (kg/m(2)) and weight-related behaviors using descriptive statistics, unadjusted, and adjusted statistical analyses. RESULTS: Study sample (n=146) was 70% female with a mean age of 57 years. More patients (57%) selected WW, followed by usual care (27%) or TC (16%). Age, gender, clinician recommendation, and counseling program characteristics were influential in counseling selections. Weight Watcher's participants and those in TC, reported statistically significant weight loss, WW participants also reported significant increases in fruit/vegetable intake; after 4 months compared with usual care. CONCLUSIONS: This practice-based intervention utilizing community counseling referrals was associated with positive health behavior change. PRACTICE IMPLICATIONS: Identifying influential factors related to patient weight counseling choices may help guide referrals to community programs. [ABSTRACT FROM AUTHOR]

This study analyzed data collected by the U.S. Army's Family Advocacy Program, the group primarily responsible for family violence prevention, identification, evaluation, treatment, and follow-up on Army installations. Patterns of spouse abuse and child abuse perpetrated within a five year period (2000-2004) were examined in a sample of 10,864 Army Soldiers who were substantiated for family violence offenses. Three groups of family violence offenders were compared: (1) those who perpetrated spouse offenses only; (2) those who perpetrated child offenses only; and (3) those who perpetrated both spouse and child offenses. Results showed that the majority of substantiated family violence offenders were spouse offenders who had not committed child abuse (61%), followed by child offenders who had not committed spouse abuse (27%), and finally those who committed both spouse and child offenses (12%). The three groups of family violence offenders differed in terms of the types of abuse they perpetrated (neglect of children, emotional abuse, physical abuse, and sexual abuse), their experiences of being a spouse abuse victim, and sociodemographic characteristics. Twelve percent of all spouse abusers committed multiple spouse abuse incidents, and 10% of all child abusers committed multiple child abuse incidents. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: A randomized controlled trial. OBJECTIVES: To determine 1) whether, among patients with persistent disabling low back pain (LBP), a group program of exercise and education using a cognitive behavioral therapy (CBT) approach, reduces pain and disability over a subsequent 12-month period; 2) the cost-effectiveness of the intervention; and 3) whether a priori preference for type of treatment influences outcome. SUMMARY OF BACKGROUND DATA: There is evidence that both exercise and CBT delivered in specialist settings is effective in improving LBP. There is a lack of evidence on whether such interventions, delivered by trained individuals in primary care, result in improved outcomes. METHODS: The study was conducted in nine family medical practices in East Cheshire, UK. Patients 18 to 65 years of age, consulting with LBP, were recruited; those still reporting LBP 3 months after the initial consultation were randomized between the two trial arms. The intervention arm received a program of eight 2-hour group exercise session over 6 weeks comprising active exercise and education delivered by physiotherapists using a CBT approach. Both arms received an educational booklet and audio-cassette. The primary outcome measures were pain (0-100 Visual Analogue Scale) and disability (Roland and Morris Disability Scale; score 0-24). RESULTS: A total of 196 subjects (84%) completed follow-up 12 months after the completion of the intervention program. The intervention showed only a small and nonsignificant effect at reducing pain (-3.6 mm; 95% confidence interval, -8.5, 1.2 mm) and disability (-0.6 score; 95% confidence interval, -1.6, 0.4). The cost of the intervention was low with an incremental cost-effectiveness ratio of pound5000 (U.S. $8650) per quality adjusted life year. In addition, patients allocated to the intervention that had expressed a preference for it had clinically important reductions in pain and disability. CONCLUSIONS: This intervention program produces only modest effects in reducing LBP and disability over a 1-year period. The observation that patient preference for treatment influences outcome warrants further investigation. [ABSTRACT FROM AUTHOR]

PURPOSE: In 2004, a commentary by Merenstein was published in JAMA describing how he was sued for engaging a patient in shared decision making for prostate cancer screening. The article sparked considerable debate on the impact of litigation on medical care. A natural experiment (a study assessing shared decision making under way at the practice that was sued) enabled us to evaluate whether physicians changed their prostate cancer screening behavior after the lawsuit. METHODS: As part of a randomized controlled trial conducted between January 2002 and November 2004, patients and physicians completed exit questionnaires about prostate cancer screening discussions after health maintenance examinations. We compared responses before, during, and after physicians became aware of the lawsuit. RESULTS: A total of 432 of 497 patients completed questionnaires (180 before the practice became aware of the lawsuit, 87 as knowledge of the case diffused through the practice, and 165 after publication of Merenstein's commentary). Comparing patients' responses over the 3 time periods, there were no changes in the average locus of decision-making control, time spent discussing screening, number of screening topics discussed, knowledge scores, or decisional conflict. The frequency with which physicians reported performing prostate-specific antigen testing increased (before vs after: 84% vs 90%; P = .03), and physicians were more likely to report that they, rather than the patients, had made the screening decision (before vs after: 3.3% vs 11.1%; P = .003). CONCLUSIONS: The physicians in closest proximity to this well-known legal case continued to engage patients in shared decision making and to let patients decide whether to be screened. Prostate-specific antigen testing increased during this period. [ABSTRACT FROM AUTHOR]

Studies show that symptom-triggered dosing is best for treatment of alcohol withdrawal in patients on chemical dependence wards without other illness. On general medical hospital wards, withdrawal may be affected by comorbid medical illness. A clinical trial was undertaken to determine whether there is a difference between symptom-triggered (ST) and fixed-schedule (FS) dosing of lorazepam in patients hospitalized on general medical wards at a university medical center. One hundred eighty-three subjects were assessed by their nurses with the Revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Subjects in the ST arm received lorazepam doses based on CIWA-Ar score. Subjects in the FS arm received scheduled lorazepam with tapering over 4 days. Symptom-triggered dosing for alcohol withdrawal for general medicine inpatients results in less lorazepam given with similar reduction in CIWA-Ar scores for the first 2 days, but a higher proportion of protocol errors. [ABSTRACT FROM AUTHOR]

Background: Patients may adopt active and/or passive coping strategies in response to pain. However, it is not known whether these strategies may also precede the onset of chronic symptoms and, if so, whether they are independent predictors of prognosis.Aim: To examine, in patients with low back pain in general practice, the prognostic value of active and passive coping styles, in the context of baseline levels of pain, disability and pain duration.Design Of Study: Prospective cohort study.Setting: Nine general practices in north west England.Method: Patients consulting their GP with a new episode of low back pain were recruited to the study. Information on coping styles, pain severity, disability, duration, and a brief history of other chronic pain symptoms was recorded using a self-completion postal questionnaire. Participants were then sent a follow-up questionnaire, 3 months after their initial consultation, to assess the occurrence of low back pain. The primary outcome was persistent disabling low back pain, that is, low back pain at 3-month follow-up self-rated as >or=20 mm on a 100 mm visual analogue scale, and >or=5 on the Roland and Morris Disability Questionnaire.Results: A total of 974 patients took part in the baseline survey, of whom 922 (95%) completed a follow-up questionnaire; 363 individuals (39%) reported persistent disabling pain at follow-up. Persons who reported high levels of passive coping experienced a threefold increase in the risk of persistent disabling low back pain (relative risk [RR] = 3.0; 95% confidence interval [CI] = 2.3 to 4.0). In contrast, active coping was associated with neither an increase nor a decrease in the risk of a poor prognosis. After adjusting for baseline pain severity, disability, and other measures of pain and pain history, persons who reported a high passive coping score were still at 50% increased risk of a poor outcome (RR = 1.5; 95% CI = 1.1 to 2.0).Conclusion: Patients who report passive coping strategies experience a significant increase in the risk of persistent symptoms. Further, this risk persists after controlling for initial pain severity and disability. The identification of this low back pain subgroup may help target future treatments to those at greatest risk of a poor outcome. [ABSTRACT FROM AUTHOR]

BACKGROUND:: We examined the association between the use of inhalants, marijuana, and other drugs and recent DSM-IV substance use disorders among adolescents aged 12-17 years. METHODS:: Data were drawn from 2000 to 2001 National Household Surveys on Drug Abuse. Adolescents aged 12-17 years who reported having ever used an illicit drug in their lifetime were categorized into four mutually exclusive groups: inhalant users (16%), marijuana users (53%), inhalant and marijuana users (16%), and other drug users (15%). Logistic regression models were used to estimate associations with recent substance use diagnoses among lifetime adolescent drug users (N=10,180). RESULTS:: We found that 31% of lifetime drug users reported having never used marijuana. One half of these atypical drug users were predominantly nonmedical users of pain relievers. Adolescents who used inhalants or other drugs but not marijuana were least likely to report multidrug use. Adolescents who reported using both inhalants and marijuana were most likely to use three or more classes of drugs (73%) and to receive a diagnosis of past year alcohol (35%) and drug (39%) abuse or dependence. CONCLUSIONS:: Our study findings suggest that among lifetime adolescent drug users, those who use both inhalants and marijuana are at very high risk for alcohol and drug use disorders. [ABSTRACT FROM AUTHOR]

The feasibility of training large numbers of community health advisors as research partners (CHARPs) was evaluated using talking circles data and cancer activity questionnaires and logs. The talking circles data indicated that the CHARPs (n=108) valued their training and believed they learned necessary research partner skills. A review of contacts (n=7,956) provided evidence that CHARPs (n=883) could work as a team to deliver a variety of services over time to the community. The findings suggested that implementing a large scale intervention with CHARPs has the potential to increase the dissemination of cancer information and to reduce cancer disparities. [ABSTRACT FROM AUTHOR]

CONTEXT: Whether Title VII funding enhances physician supply in underserved areas has not clearly been established. PURPOSE: To determine the relation between Title VII funding in medical school, residency, or both, and the number of family physicians practicing in rural or low-income communities. METHODS: A retrospective cross sectional analysis was carried out using the 2000 American Academy of Family Physicians physician database, Title VII funding records, and 1990 U.S. Census data. Included were 9,107 family physicians practicing in 9 nationally representative states in the year 2000. FINDINGS: Physicians exposed to Title VII funding through medical school and residency were more likely to have their current practice in low-income communities (11.9% vs 9.9%, P< or =.02) and rural areas (24.5% vs 21.8%, P< or =.02). Physicians were more likely to practice in rural communities if they attended medical schools (24.2% vs 21.4%; P =.009) and residencies (24.0% vs 20.3%; P =.011) after the school or program had at least 5 years of Title VII funding vs before. Similar increases were not observed for practice in low-income communities. In a multivariate analysis, exposure to funding and attending an institution with more years of funding independently increased the odds of practicing in rural or low-income communities. CONCLUSIONS: Title VII funding is associated with an increase in the family physician workforce in rural and low-income communities. This effect is temporally related to initiation of funding and independently associated with effect in a multivariate analysis, suggesting a potential causal relationship. Whereas the absolute 2% increase in family physicians in these underserved communities may seem modest, it can represent a substantial increase in access to health care for community members. [ABSTRACT FROM AUTHOR]

Background: Plantar fasciitis is one of the more common soft-tissue disorders of the foot, yet little is known about its etiology. The purpose of the present study was to use an epidemiological design to determine whether risk factors for plantar fasciitis could be identified. Specifically, we examined the risk factors of limited ankle dorsiflexion with the knee extended, obesity, and time spent weight-bearing.Methods: We used a matched case-control design, with two controls for each patient. The matching criteria were age and gender. We identified fifty consecutive patients with unilateral plantar fasciitis who met the inclusion criteria. The data that were collected included height, weight, whether the subject spent the majority of the workday weight-bearing, and whether the subject was a jogger or runner. We used a reliable goniometric method to measure passive ankle dorsiflexion bilaterally. The main outcome measure was the adjusted odds ratio of plantar fasciitis associated with varying degrees of limitation of ankle dorsiflexion, different levels of body mass, and the subjects' reports on weight-bearing.Results: Individuals with 10 degrees of ankle dorsiflexion. Individuals who had a body-mass index of >30 kg/m (2) had an odds ratio of 5.6 (95% confidence interval, 1.9 to 16.6) when compared with the referent group of individuals who had a body-mass index of Conclusions: The risk of plantar fasciitis increases as the range of ankle dorsiflexion decreases. Individuals who spend the majority of their workday on their feet and those whose body-mass index is >30 kg/m (2) are also at increased risk for the development of plantar fasciitis. Reduced ankle dorsiflexion, obesity, and work-related weight-bearing appear to be independent risk factors for plantar fasciitis. Reduced ankle dorsiflexion appears to be the most important risk factor. [ABSTRACT FROM AUTHOR]

Since publication of CDC's 1993 guidelines (CDC. Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. MMWR 1993;42[No. RR-12]:1--39), nucleic acid amplification tests (NAATs) have been introduced as critical new tools to diagnose and treat C. trachomatis and Neisseria gonorrhoeae infections. NAATs for C. trachomatis are substantially more sensitive than previous tests. When using a NAAT, any sacrifice in performance when urine is substituted for a traditional swab specimen is limited, thus reducing dependence on invasive procedures and expanding the venues where specimens can be obtained. NAATs can also detect both C. trachomatis and N. gonorrhoeae organisms in the same specimen. However, NAATs are usually more expensive than previous tests, making test performance from an economic perspective a key consideration.This report updates the 1993 guidelines for selecting laboratory tests for C. trachomatis with an emphasis on screening men and women in the United States. (In this report, screening refers to testing persons in the absence of symptoms or signs indicating C. trachomatis or N. gonorrhoeae infection.) In addition, these guidelines consider tests from an economic perspective and expand the previous guidelines to address detection of N. gonorrhoeae as well as C. trachomatis infections. Because of the increased cost of NAATs, certain laboratories are modifying manufacturers' procedures to improve test sensitivity without incurring the full cost associated with screening with a NAAT. Such approaches addressed in these guidelines are pooling of specimens before testing with a NAAT and additional testing of specimens whose non-NAAT test result is within a gray zone. This report also addresses the need for additional testing after a positive screening test to improve the specificity of a final diagnosis.To prepare these guidelines, CDC staff identified pertinent concerns, compiled the related literature published during 1990 or later, prepared tables of evidence, and drafted recommendations. Consultants, selected for their expertise or disciplinary and organizational affiliations, reviewed the draft recommendations. These final guidelines are the recommendations of CDC staff who considered contributions from scientific consultants. These guidelines are intended for laboratorians, clinicians, and managers who must choose among the multiple available tests, establish standard operating procedures for collecting and processing specimens, interpret test results for laboratory reporting, and counsel and treat patients. [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Abstract Large numbers of observational studies have described a decrease in the incidence of cardiovascular disease in women taking hormone replacement therapy (HRT). The potential mechanisms for this effect are numerous, including direct effects on lipid levels and lipid metabolism, cardiovascular dynamics, and endothelial reactivity. The beneficial effects of HRT are probably affected by various factors, including the age of onset of therapy, the presence of coronary artery disease, the type of estrogen and whether it is used in combination with progesterone, concurrent modification of other cardiac risk factors, and duration of therapy. Until further prospective clinical trials are done, HRT should be considered in those women for whom the potential benefits exceed the potential risks, on the basis of an individualized patient evaluation.